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Diagnostic Imaging of Osteomyelitis of the Foot and Ankle

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Osteomyelitis of the Foot and Ankle

Abstract

Accurate diagnosis of osteomyelitis is critical for early initiation of treatment of infection and preservation of the foot. Imaging plays an important role in diagnosis of osteomyelitis. Imaging diagnosis often begins with radiographs due to their availability and low cost. Frequently X-rays don’t provide a definitive diagnosis and the patient requires further imaging. Magnetic resonance imaging (MRI) is the diagnostic test of choice due to its good spatial and anatomic resolution, ability to image soft tissues as well as bones, high sensitivity and specificity as well as its wide availability. The combination of confluent low signal in the marrow on T1 weighted scans, high signal intensity within the marrow on T2 weighted scans and enhancement in the marrow post contrast in the presence of a skin ulcer that extends down to bone are the most useful signs on MRI for diagnosis of osteomyelitis. Patients with underlying neuroarthropathy present special challenges for diagnosis of osteomyelitis. This is due to the underlying disorganization and marrow edema that is often present secondary to the preexisting neuroarthropathy. Nuclear medicine studies such as technetium-labeled bone scan, white blood cell scans, and FDG-PET scans are also useful for diagnosis of osteomyelitis in patients for whom MRI is contraindicated or as problem-solving tools in patients with underlying neuroarthropathy.

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Authors and Affiliations

  1. St. Paul Radiology and HealthPartners, 767 Linwood Ave, St. Paul, MN, 55015, USA

    Susan B. Truman M.D.

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  1. Susan B. Truman M.D.
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Correspondence to Susan B. Truman M.D. .

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  1. Regions Hospital/HealthPartners, Institute for Education and Research, St. Paul, Minnesota, USA

    Troy J. Boffeli

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Truman, S.B. (2015). Diagnostic Imaging of Osteomyelitis of the Foot and Ankle. In: Boffeli, T. (eds) Osteomyelitis of the Foot and Ankle. Springer, Cham. https://doi.org/10.1007/978-3-319-18926-0_3

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  • DOI: https://doi.org/10.1007/978-3-319-18926-0_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18925-3

  • Online ISBN: 978-3-319-18926-0

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